Haglund's deformity

Some people have a natural prominence of the heel bone (calcaneus) at the rear on the outside edge just where the Achilles tendon attaches. It is often evident on xrays, but CT scans show it more clearly. If large, this is called Haglund's deformity.  Unfortunately this is where shoes need to grip at the heel and if friction occurs an angry red soft tissue swelling (bursitis) can occur which simply makes the lump bigger and the friction worse.  The Achilles tendon itself can begin to develop friction against this bony prominence causing tendon pain and another area of painful bursitis deeper in the hindfoot. If the tendon itself seems to be involved, an MRI scan is sometimes helpful.

If the swelling and bursitis are on the back of the heel, wearing trainers, backless shoes or applying padding for a while can break the cycle of inflammation and swelling. Occasionally the build-up of firm tissue over the bony prominence is too resistant and surgical resection is warranted. If the problem is deeper inside between the bone and front edge of the calcaneus, a single steroid injection can be tried although there is a risk of precipitating a rupture of the Achilles tendon. If the pain does not settle despite rest, physiotherapy and avoidance of aggravating activities, surgery should be considered. The aim of surgery is treatment of the pain by removal of the prominent bone so that it no longer presses on either the shoes or Achilles tendon. (Excision of Haglund's deformity). We now carry this out by keyhole surgery whenever possible.

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